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Permit
? / /G 9 ----- ?€-1)/ 4 --/-e- /- CITY OF TIGARD ELECTRICAL PERMIT IN q 0 - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00445 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009 Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 92 Subdivision: Lot: 0 Project: Spec Space Project Description: New service and (6) branch circuits. 9/9/09, adding (1) feeder. Owner: FEES 13500 PACIFIC CORP Quantity Description Date Amount BY CAPOZZOLI ADVISORY FOR, PENSIONS INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Services or Feeders 200 09/02/2009 $80.30 amps or less • PHONE: 6 crt Branch Circuits w /Purchase 09/02/2009 $39.90 Service or Feeder 1 ea 12% State Surcharge - 09/02/2009 $14.42 Contractor: Electrical TED MEEKER ELECTRIC 1 ea Services or Feeders - 200 09/09/2009 $80.30 P.O. BOX 788 amps or less NEWBURG, OR 97132 10 da 12% State Surcharge - 09/09/2009 $9.64 PHONE: 503 - 538 -3845 Electrical (manual) FAX: 503 - 537 -5011 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $224.56 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accord- • - • • approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTE •N: Oregon la req ' -s you . to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 • through OAR 952 -001 ! '0. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 3 . 344. / 4 Issued By: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' 1 Date: LICENSE NO. Call 503.839.4176 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project Approved plans are required on the Job site at the time of each Inspection. CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00445 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009 Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 92 Subdivision: Lot: 0 Project: Spec Space Project Description: New service and (6) branch circuits. Owner: FEES 13500 PACIFIC CORP Quantity Description Date Amount BY CAPOZZOLI ADVISORY FOR, PENSIONS 1 ea Services or Feeders - 200 09/02/2009 $80.30 INC, 21500 HAGGERTY ROAD, SUITE 100 amps or less PHONE: 6 crt Branch Circuits w /Purchase 09/02/2009 $39.90 Service or Feeder 1 ea 12% State Surcharge - 09/02/2009 $14.42 Contractor: Electrical TED MEEKER ELECTRIC P.O. BOX 788 NEWBURG, OR 97132 PHONE: 503 - 538 -3845 FAX: 503- 537 -5011 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: • Total $134.62 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire If work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT • • ' : • r- • .• law r- • ires you to follow the rules adopted by the Oregon Utility Notification Center. Tho a rules are set forth in OAR 952 -001 110 through OAR 952- • -0101. : u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.80•,: `2344. Issued : : - I : % . Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: A INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept In a conspicuous place on the Job site until completion of the project Approved plans are required on the job site at the time of each inspection. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Date /B : - ©D On Permit No.: fi,'D e q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review III • Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: T I G A R D Inspection Line: 503.639 Date ReadyBy: BM See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information • TYPE OF WORK PLAN REVIEW ❑ New construction .Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION • ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", • Job no.: Job site address: 3 5 c7v S4✓ g e 1414, 1001113 or more. occupancy. :1 Six or more residential units. ❑ Recreational vehicle parks. City/State /Z[P: (r /`'g 1 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: W4 P. Project name: / /e_ p41-0_ ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 I Tax map /parcel no.: Limited energy, residential 75.00 2 • DESCRIPTION OF WORK (with above sq. ft.) • / � 1 Limited energy, multi - family / t .4! .) S 4W v/ C residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and /or relocation 200 amps or less ) 80.30 '•, ,[) 2 ❑ PROPERTY OWNER, l ❑ TENANT - - 201 amps to 400 amps 106.85 2 Name: • 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑. CONTACT PERSON above service or feeder fee, 6.65 taJ l , QD 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, >� 46.85 2 first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 90.90 2 dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: T� 'A i Signal circuit(s) or limited - k ,C.2 /re /L L e energy panel, alteration, or Address: p ~ ex ,e.V extension. Describe: Page 2 2 City/State /ZIP: 1,44i K 1 ` O1,--0 (, 12._ q7 /3 2_ Each additional inspection over allowable in any of the above L Per inspection 62.50 Phone:) 5S -, C! Z g9 Fax: (5 CO 53.7 .. S a / / Investigation per hour (1 hr min) 62.50 CCB Lic.: /Q Coy Z Electrical Lic.: 3 / -` ^ C Supry . Lic.32p,S Industrial plant per hour 73.75 // ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: 46.4 0 Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): /y' 9 a Authorized signature: TOTAL PERMIT FEE: /3e/.6A This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. IA\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(t1/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ A udio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ I nstrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ O utdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations I: \Building\Permits\ELC- PermitApp.doc 03/23/06